106例腰骶段结核患者经后路手术治疗的效果评价  

Clinical efficacy evaluation of one-stage posterior debridement, bony graft and instrumentation for 106 patients of lumbosacral tuberculosis

作　　者：李元[1] 董伟杰[1] 兰汀隆[1] 范俊[1] 秦世炳[1] 

机构地区：[1]首都医科大学附属北京胸科医院骨科,101149

出　　处：《中国防痨杂志》2017年第4期348-352,共5页Chinese Journal of Antituberculosis

基　　金：北京市科技计划课题（D141107005214002）

摘　　要：目的探讨后路手术治疗腰骶段结核的临床效果及相关风险。方法回顾性分析2001年1月至2016年1月，在北京胸科医院骨科接受后路手术治疗的106例腰骶段结核患者的病例资料。其中，男61例，女45例；年龄18-85岁，平均（52．7±16．5）岁。统计手术时间、术中出血量、术后并发症、术后复发率、术后疼痛视觉模拟评分（visual analogue scale，VAS）改善情况、术后植骨融合率、术后腰骶角变化、术后生活质量[采用《生活质量评定简表SF-36（shortform-36）》进行生活质量评分，以下简称“SF-36评分”]改善等情况，综合上述因素评价后路手术在治疗腰骶段结核患者中的临床效果及相关风险。结果本组患者手术时间105～400min，平均（211．8±63．1）min。术中出血量200-800ml，平均（420．0±56．1）ml。11例患者出现术后并发症，术后并发症发生率为10．4％（11／106）。术后3例患者复发，术后复发率为2．8％（3／106）。术前VAS评分为3～8分，平均（6．2±1．6）分；术后VAS评分为0～5分，平均（1．8±1．5）分，两者差异有统计学意义（t=15．03，P=0．000）。依据Moon植骨融合标准，99例植骨融合，7例未融合，植骨融合率为93．4％0（99／106）；植骨融合时间3～10个月，平均（5．2±1．6）个月。术前腰骶角为17°～30°，平均（21．1±4．2）°；末次随访时腰骶角为24°～35°，平均（28．8±3．4）°，差异有统计学意义（t=3．89，P=0．002）。美国脊柱损伤协会神经功能分级（ASIA）12例术前为D级的患者，末次随访时均改善至E级。末次随访时患者的SF-36评分结果较术前有明显改善，术前生理健康综合测量评分为（32．4±9．2）分，术后为（83．8±7．4）分，差异有统计学意义（t=11．83，P=0．000）。术前心理健康综合测量评分为（48．4±14．6）分，术后为（89．5±5．3）分，差异有统计�Objective To evaluate the clinical efficacy and risks of one-stage posterior debridement, bony graft and instrumentation for lumbosacraI tuberculosis. Methods During Jan 2001 to Jan 2016,the records of 106 patients suffering from lumbosacral tuberculosis were analyzed retrospectively. There were 61 male and 45 female patients. Age ranged from 18 to 85 years, and mean age was （52.7±16.5） years. All the 106 patients received onestage posterior debridement, bony graft and instrumentation. The factors of operation time, blood loss, postopera tive complications, recurrence rate, visual analogue scale （VAS）, bony graft fusion rate, lumbosacral angle, living quality （Short Form-36 Health Survey） were analyzed, to evaluate the clinical efficacy and risks of one-stage posterior debridement,bony graft and instrumentation for lumbosacral tuberculosis. Results In this study, operation time was 105-400 min, and mean operation time was （211.8±63.1） min. Blood loss was 200-800 ml, and mean blood loss was （420.0±56.1） ml. Eleven patients had postoperative complications with 10.4% （11/106） of postoperative complications rate. Three patients recurred, and the recurrence rate was 2. 8; （3/106）. Preoperative VAS was 3- 8 score, and mean preoperative VAS was （6.2±1.6） score. Postoperative VAS was 0-5 score, and mean postoperative VAS was （1.8±1.5） score, there was statistical difference （t=15.03, P=0. 000）. By Moon＇s standard, bony grafts of 99 patients fused, and bony grafts of 7 patients absorbed, the rate of bony grafts fusion was 93.4% （99/106）. Fusion time was 3-10 months, and mean fusion time was （5.2±1.6） months. Preoperative lumbosacral angle was 17°- 30°, and mean preoperative lumbosacral angle was （21.1 ± 4.2）°. Final follow-up lumbosacral angle was 24°- 35°, and mean lumbosacral angle was （28.8± 3.4）°, and there was statistical difference（t = 3.89, P = 0. 002）. When final follow-up, 12 patients of ASIA classification D improved to ASIA classificati

关 键 词：脊柱结核 腰椎 骶椎 外科手术的选择性 方案评价 

分 类 号：R681.53[医药卫生—骨科学]